Psychosocial correlates of HIV protection motivation among black adolescents in Venda, South Africa

An Integrated Approach to COVID-19 Preventive Behaviour Intentions: Protection Motivation Theory, Information Acquisition, and Trust

COVID-19 has been a global threat since November 2019 due to its high transmission rates and the issue of unwillingness to vaccinate. Effective risk management requires accurate health communication and public compliance with reccomended preventive behaviors. Therefore, we investigated predictors of COVID-19 preventive behavior intention based on Protection Motivation Theory (PMT) in addition to frequency of public's use of and trust in a group of COVID-19 related information sources. This cross-sectional study was conducted on 458 adults in Turkey with online survey. Results showed that all PMT components (except perceived susceptibility) accounted for 49% of the variance in protection motivation and there was relationship between information sources and protection motivation. Overall, our study findings suggested that being more informed and having confidence in the feasibility (self-efficacy) and effectiveness (response efficacy) of preventive behaviors may particularly help slow the disease spread.

Youths' Perceptions Of The Relation Between Alcohol Consumption And Risky Sexual Behaviour in the Western Cape, South Africa: A Qualitative Study

The purpose of this study is to explore the factors that youth identify as contributing to alcohol consumption, and more specifically its relation to risky sexual behaviour among youth. We employed an exploratory qualitative method using focus group discussions with 34 young people between the ages of 18-25-years-old in low socio-economic status communities in the Western Cape province of South Africa. Data were analyzed thematically utilizing Braun and Clarke's (2006) six-step thematic analysis process. We identified two thematic domains pertaining to alcohol consumption and risky sexual behaviour, namely individual and social factors, each comprising three themes. The individual factors thematic domain comprises intrapersonal influences, employment and educational attainment; while the social factors thematic domain includes interpersonal influences, social influences, and hope for the future. Youth living in low socio-economic status communities were thought to be at greater risk of alcohol misuse and subsequent risky behaviour, given the political and social history of marginalisation, systematic oppression, and social inequality. To address alcohol use and risky sexual behavior among youth, we recommend interventions with adolescents, parents or guardians, and the community. More specifically, interventions aimed at adolescents should focus on the transition to young adulthood. Interventions with parents should focus on their role in modelling and potentially regulating alcohol consumption. Finally, community interventions should centre on drinking behaviors, levels of drinking, what constitutes harmful drinking, and how to identify when treatment and recovery support is likely to be required.

Using Protection Motivation Theory to Predict Adherence to COVID-19 Behavioral Guidelines

COVID-19 has become a global pandemic. Throughout most of the pandemic, mitigating its spread has relied on human behavior, namely on adherence to protective behaviors (e.g., wearing a face mask). This research proposes that Protection Motivation Theory (PMT) can contribute to understanding differences in individual adherence to COVID-19 behavioral guidelines. PMT identifies four fundamental cognitive components that drive responses to fear appeals: perceptions of susceptibility (to the disease), severity (of the disease), self-efficacy (to protect oneself), and response efficacy (i.e., recommended behaviors' effectiveness). Two online self-report studies assessed PMT components' capacity to predict adherence to protective behaviors concurrently and across culturally different countries (Israel, Germany, India; Study 1), and again at six-week follow-up (Israeli participants; Study 2). Study 1's findings indicate excellent fit of the PMT model, with about half of the variance in adherence explained. No significant differences were found between participants from Israel (n = 917), Germany (n = 222) and India (n = 160). Study 2 (n = 711) confirmed that PMT components continue to predict adherence after six weeks. In both studies, response efficacy was the PMT component most strongly associated with adherence levels. This study demonstrates that PMT can serve as a theoretical framework to better understand differences in adherence to COVID-19 protective behaviors. The findings may further inform the design of adherence-promoting communications, suggesting that it may be beneficial to highlight response efficacy in such messages.

Trust in Science, Perceived Vulnerability to Disease, and Adherence to Pharmacological and Non-pharmacological COVID-19 Recommendations

Protection motivation theory (PMT) is a theoretical framework informative for understanding behavioral intentions and choices during exceptional and uncommon circumstances, such as a pandemic of respiratory infectious disease. PMT postulates both the threat appraisal and the coping appraisal as predictors of health behaviors. Recent advances in the field of behavioral immune system (BIS) research suggest that humans are equipped with a set of psychological adaptations enabling them to detect the disease-threat and activate behavioral avoidance of pathogens. The present study, set within PMT framework and informed by the BIS research, aimed to explain and predict voluntary adherence to COVID-19 guidelines by perceived personal risk and vulnerability to disease as threat appraisal variables, and trust in science as the response efficacy element of coping appraisal. Gender, age, belief in the second wave, perceived personal risk, germ aversion, and trust in science were all found to be significant positive predictors of the intent to adhere to non-pharmacological COVID-19 recommendations, with the belief in the second wave, germ aversion, and trust in science being the most important ones. On the other hand, only the belief in the second wave and trust in science were significant positive predictors of the intent to adhere to pharmacological COVID-19 recommendations (i.e., to vaccinate). Interventions aimed at enhancing preventative measures adherence should take into account that the psychological mechanisms underlying adherence to these two types of recommendations are not identical.

Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory

Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention. Methods: We analyzed baseline data from the sample of 267 AIs, ages 13-19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience. Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth. Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.

Differences in the ability to predict and prepare for sexual activity between HIV-infected and HIV-uninfected young South African Women

The Human Research Council's National HIV Prevalence, Incidence and Behavior Survey ranks South Africa first in HIV incidence in the world with 400,000 new infections in 2012 and found the HIV incidence rate among female youth aged 15 to 24 years to be 2.5% that year. The objective of this study was to compare the pattern and predictability of sexual activity between HIV-infected and HIV-uninfected young South African women. Sexually active young women between the ages of 16 and 21 years old completed a study survey between October 2012 and 2014 at two Desmond Tutu HIV Foundation centers. 100 young women with a mean age of 19.04 years responded to the survey. 51 women (51%) were HIV-infected and 49 were HIV-uninfected (49%). HIV-infected young women were found to be statistically less likely to have a temporal pattern to their sexual activity as compared to HIV-uninfected young women (56.9 vs. 95.9%, p<0.0001). While controlling for frequency of sex and lifetime sexual partners, HIV status remains a significant predictor of having a pattern of sexual activity (OR=16.13, p=0.0004) and a predictor of having sex on the weekend only (OR=4.41, p=0.0022). The ability to predict when sexual activity will occur enables a woman to prepare for its associated risks. HIV-uninfected young women are more likely to have a predictable pattern to their sexual activity as compared to HIV-infected young women. Knowledge of the sexual behavior patterns of this high-risk population will aid in the development of effective HIV prevention campaigns.

Understanding the Adolescent Gap in HIV Testing Among Clients of Antenatal Care Services in West and Central African Countries

New HIV infections among children have declined significantly more slowly in West and central African countries (WCA) than in eastern and southern African countries between 2009 and 2015. Since adolescent fertility is particularly high in WCA countries, frequent mother-to-child transmission (MTCT) of HIV may in part be due to low coverage of HIV testing among adolescents during antenatal care (ANC). We investigated this adolescent gap in HIV testing using survey data from the demographic and health surveys and multiple indicators cluster surveys collected in 21 WCA countries since 2009. We found significant adolescent gaps in HIV testing in 12 out of 21 WCA countries, with the largest gap observed in Nigeria. In countries with a significant adolescent gap in HIV testing, we used Fairlie decompositions to assess what proportion of these gaps were explained by age-related differences in the distribution of (a) marital status, (b) socioeconomic status (SES), (c) MTCT-related knowledge, and (d) patterns of ANC utilization. Differences in SES and MTCT-related knowledge were the most consistent determinants of adolescent gaps in HIV testing during ANC. Differences in ANC utilization (e.g., fewer and possibly delayed ANC visits) also contributed to the adolescent gap in 8 out of 12 countries. Interventions that improve knowledge of MTCT risks, and/or promote the sustained use of ANC services, could help engage HIV-infected adolescents who become pregnant in PMTCT services. Targeting these interventions at the most disadvantaged households will be crucial in further reducing HIV infections among children.

The psychosocial determinants of the intention to avoid sexual engagement when intoxicated among young men in KwaZulu-Natal, South Africa

BACKGROUND

A cross sectional study was conducted among 350 sexually active, mainly unemployed men between the ages of 18 and 35 in KwaZulu-Natal. This study examined the psychosocial determinants of the intention to be sexually active after having used marijuana or alcohol personally or in instances when the sexual partner is intoxicated. The theory of planned behaviour and cultural notions of responsible manhood were used in developing the measures.

METHODS

Correlation and hierarchical stepwise linear regression analyses tested determinants of the intention to avoid having sex when personally intoxicated and the intention to avoid sex when the sexual partner is intoxicated.

RESULTS

About 78 % of the participants reported regular use of alcohol and 39 % indicated ever-using marijuana. A total of 36.3 % used both alcohol and marijuana, and 73 % said that they engaged in multiple sexual partner behaviour. The intention to avoid sex when personally intoxicated as well as the intention to avoid sex when the sexual partner is intoxicated were significantly associated with subjective norms and perceptions of perceived behavioural control towards the respective behaviours, and less with attitudes towards the respective behaviours.

CONCLUSIONS

These findings imply that health education interventions should focus on changing the normative beliefs as well as control beliefs of the target population either directly through education and training or indirectly by creating physical and social environments that facilitate safe sexual practices, for example by organizing positive peer support for risk prevention and by making condoms freely available in community alcohol serving establishments.

Psychosocial determinants of intention to use condoms among Somali and Ethiopian immigrants in the U.S

The study examined potential psychosocial determinants of male condom use in steady heterosexual relationships among Somali and Ethiopian immigrants in Minnesota in two sequential phases: the elicitation (Phase I) and cross-sectional quantitative studies (Phase II). Information from Phase I was used to develop the instrument for Phase II. Study participants who self-identified as Somali and Ethiopian immigrants (n = 205) responded to questions on demographic characteristics, attitudes (affective and instrumental), norms (subject and descriptive), perceived behavioral control, self-efficacy, and intention to use male condoms. Hierarchical regression models were used to assess the relationship between the main independent variables (attitude norms, perceived behavioral control, and self-efficacy, and the dependent variable, the intention to use male condoms. Overall, participants showed low intention and slightly favorable (affective and instrumental) attitudes toward condom use; had experienced weak, but positive social influence as measured by injunctive and descriptive norms. Moreover, study participants had shown slight perceived behavioral control, but had fairly moderate positive self-efficacy. The Theory of Planned Behavior was moderately effective in predicting condom use; however, the Integrated Behavioral Model, explained nearly 40% of the variations in the intention to use male condoms. Among men, self-efficacy had the strongest influence (β = .44, p < .001) on behavioral intention. Among women, descriptive norms (β = .22, p < .05) exerted the strongest effect (model 3). Improving self-efficacy, specifically, among older men, and fostering desirable normative influence among women, are suggested as main components of public health interventions to promote condom use among Somali and Ethiopian immigrants.

Sociocognitive Predictors of Condom Use and Intentions Among Adolescents in Three Sub-Saharan Sites

Many HIV intervention programs in sub-Saharan Africa have applied social cognitive theories such as the theory of planned behavior. However, a recent sub-Saharan African review was unable to show increased effectiveness for theory-based interventions. This study assessed whether the predictive value of attitudes, subjective norms, self-efficacy, and intention was similar to studies in Europe and the U.S., and whether there were differences between three sub-Saharan sites. Longitudinal multigroup structural equation modeling was used to assess whether attitudes, subjective norms, and self-efficacy predicted condom use intentions and condom use (after 6 months) among adolescents in three sites, namely Cape Town (South Africa; N = 625), Dar es Salaam (Tanzania; N = 271), and Mankweng (South Africa; N = 404). Condom use intentions were predicted by subjective norms and self-efficacy in all three sites. Attitudes were not related to intentions in Dar es Salaam and were moderately related to intentions in Cape Town and Mankweng. The proportions of explained variance in intentions and behavior were decent (37-52 and 9-19%, respectively). Although significant differences in predictive value were found between sites and in comparison to European and U.S. studies, intentions could adequately be explained by attitudes, subjective norms, and self-efficacy. However, the limited proportions of variance in behavior explained by intentions could signify the importance of contextual and environmental factors. Future studies are recommended to use an integrative approach that takes into account both individual and contextual factors, as well as social and environmental differences.

Social Norms about a Health Issue in Work Group Networks

The purpose of this study is to advance theorizing about how small groups understand health issues through the use of social network analysis. To achieve this goal, an adapted cognitive social structure examines group social norms around a specific health issue, H1N1 flu prevention. As predicted, individual's attitudes, self-efficacy, and perceived social norms were each positively associated with behavioral intentions for at least one of the H1N1 health behaviors studied. Moreover, collective norms of the whole group were also associated with behavioral intentions, even after controlling for how individual group members perceive those norms. For members of work groups in which pairs were perceived to agree in their support for H1N1 vaccination, the effect of individually perceived group norms on behavioral intentions was stronger than for groups with less agreement.

The theory of planned behaviour as a framework for predicting sexual risk behaviour in sub-Saharan African youth: A critical review

Amongst the psychological theories that have been used to help understand why people have unprotected sex, the Theory of Planned Behaviour (TPB: Ajzen 1991) has earned a prominent position. This article is a critical review of 11 peer-reviewed studies conducted in sub-Saharan Africa during 2001 to 2009, which used the TPB as a model of predicting sexual risk behaviour in young people. All the studies revealed the predictive ability of the TPB in urban, rural, and traditional African settings, with R (2) coefficients ranging between 0.14 and 0.67. With data comparing favourably to those obtained in the international literature, these studies indicate that the TPB can be used to study sexual risk intentions and behaviour in sub-Saharan African youth, and question arguments against the theory's use in non-Western settings.

HIV-prevention knowledge among illiterate and low-literate women in rural Amhara, Ethiopia

More than 85% of Ethiopia's population lives in rural areas and literacy levels in the country are relatively low. Despite this, little is known about levels of knowledge in regard to HIV/AIDS and condom use among illiterate and low-literate rural individuals. We conducted a cross-sectional study among 200 illiterate to semi-literate women, ages 13 to 24, from two rural communities in the Amhara region of northwestern Ethiopia. Nearly all the women had heard about HIV and AIDS. Among the illiterate individuals (n = 54), 24% did not know that HIV was the cause of AIDS and 48% did not know that HIV could be transmitted by sexual intercourse without a condom with an HIV-infected person. Among the same group, 59% did not know what a condom is. Literacy had a strong positive association with knowledge of HIV transmission and condoms. Thus, due to a generally higher level of literacy (grade 5-8 attainment), very young women (ages 13-20) had better knowledge of HIV transmission and condoms than did women ages 21-24 who by comparison were less literate. Given poor knowledge of HIV transmission and condoms among illiterate and low-literate women in Amhara, targeted HIV-prevention interventions are needed in this region.

Predictors of consistent condom use among Chinese female sex workers: an application of the protection motivation theory

We utilized Protection Motivation Theory to assess predictors of intention and behavior of consistent condom use among Chinese female sex workers (FSWs). A self-administered questionnaire was used in a cross-sectional survey among 700 FSWs in Guangxi, China. Multivariate logistic regression analysis indicated that extrinsic and intrinsic rewards, self-efficacy, and response costs predicted consistent condom use intention and behavior among FSWs. Sexually transmitted infection/ HIV prevention programs need to reduce FSWs' perceptions of positive extrinsic rewards and intrinsic rewards for engaging in consistent condom use, reduce FSWs' perception of response costs for using a condom, and increase condom use self-efficacy among FSWs.

Condoms in sub-Saharan Africa

Sub-Saharan Africa (SSA) is the region with the world’s highest rates of HIV and other sexually transmissible infections (STIs), yet numerous studies show that condom use is generally rare. This suggests a need for a better understanding of how condoms fit within sexual practices and relationships in SSA. This paper seeks to address this need by reviewing research published between the late 1980s and 2011 on use and factors influencing use of male condoms in SSA. What is evident from this research is that condom use involves complex social and interpersonal dynamics, with structural and cultural conditions exerting an influence through framing social cognitions and setting boundaries on autonomy that make the apparently irrational choice of eschewing condoms a rational decision. The influences of poverty; relationships with parents, peers and partners; limited, insufficient or absent information especially in rural areas and among men who have sex with men; gender and sexual norms, and the dynamics of gendered power; and beliefs and attitudes about HIV, condoms and sexuality all have been shown to work against condom use for a large proportion of Africa’s people. However, promising results are shown in trends towards increased condom use among single women in numerous countries, increasing acceptance and use of condoms among some university students, successes in producing potentially sustainable condom use resulting from select interventions, and resistance to succumbing to the dominant gender–power dynamics and structural–cultural impediments that women in groups have mobilised.

Conversation and compliance: role of interpersonal discussion and social norms in public communication campaigns

This study explores the role of interpersonal discussion and social norms in a public health campaign, the BBC Condom Normalization Campaign, designed to promote conversation and change the public perception of condom use in India. Drawing upon the integrative model of behavioral prediction, attitudes, self-efficacy, subjective norms, and descriptive norms were predicted to relate to behavioral intentions to use condoms. It is important to note that the valence of discussion was hypothesized to relate to each of these more proximal predictors. The authors used structural equation modeling to test the model on 3 separate samples of Indian men between the ages of 15 and 49 years: (a) high-risk men who had sex with nonspouses; (b) low-risk, sexually inactive, unmarried men; and (c) low-risk, monogamous, married men. Results were similar for low- and high-risk audiences, with valence of discussion about condoms predicting condom-related attitudes, self-efficacy, and subjective and descriptive social norms with respect to condom use, which, in turn, predicted behavioral intent to use condoms. These findings underscore the need to take not only the frequency but also the valence of interpersonal discussion into account when assessing the effect of health campaigns. Implications for theory and design of future public communication campaigns are explored.

Fear appeals in HIV prevention: the role of anticipated regret

The present study examined the role of a number of cognitive beliefs (i.e. attitude, subjective norm, anticipated regret, and self-efficacy) in explaining the effects of fear appeal information on behavioral motivation. A randomized experiment with a 2 (threat: low versus high) × 2 (coping: low versus high) between-subjects design was used in the study. Undergraduates were exposed to one of four scenario messages that presented high or low threat information about HIV/AIDS combined with high or low coping information with regard to condom use in HIV prevention. Explorative analyses revealed that only anticipated regret qualified as a mediator of the effect of the fear appeal message on intention. High coping information was observed to increase anticipated regret, which increased the intention to use condoms. Anticipated regret mediated the coping-intention relationship. This finding furthers our understanding of the working mechanisms of fear appeals in HIV prevention.

Understanding adolescent peer sexual harassment and abuse: using the theory of planned behavior

This study examines intentions to take protective action against peer sexual harassment and abuse (PSHA). The theory of planned behavior (TPB) proposes that attitudes about protective action, perceptions of what others would think about doing this (subjective norms), and behavioral control would be important predictors. A total of 1,531 Chinese secondary school students (769 boys and 762 girls) from Hong Kong were surveyed to test this model. Results showed that the TPB model was predictive for girls, but only subjective norms and behavioral control significantly predicted boys' intentions to protect themselves. Results supported the influence of subjective norms and perceived behavioral control on youths' intentions to reject PSHA. These factors may be useful in guiding the development of an educational program for prevention of PSHA.

Preventing HIV infection in women: a global health imperative

Women account for approximately one-half of all human immunodeficiency virus (HIV) infections worldwide. Sexual transmission is the dominant mode of HIV transmission to women, and there is a concomitant associated epidemic of transmission to infants. The majority of HIV infections in women are in sub-Saharan Africa, with a disproportionate burden in young women <25 years of age. Acquisition and prevention of HIV infection in women is complex and influenced by biological, behavioral, and structural factors. Efforts to reduce the incidence of HIV infection among women in sub-Saharan African could play a substantial role in altering global trajectories of HIV infection. Increasing access to sexual and reproductive health services, addressing gender-based violence and social instability, reducing poverty and the need to engage in sex for survival, and encouraging greater male responsibility are critical short-to-medium-term interventions. Efforts to find a microbicide and HIV vaccine need to be matched with efforts to deepen understanding of acquisition of HIV in the female genital tract to inform development of targeted molecules for prevention of HIV infection.

Using protection motivation theory to predict condom usage and assess HIV health communication efficacy in Singapore

The number of individuals infected with HIV/AIDS continues to rise in Asia. Condom use is considered to be the first line of defense against AIDS (UNAIDS, 2006). Using protection motivation theory (Rogers, 1983), this research aims to first understand the factors affecting condom usage intention among homosexual and heterosexual men in Singapore, and then to utilize those findings to assess the efficacy of HIV-directed health communications. We collected survey data from 484 men and analyzed the data using hierarchical regression and structural equation modeling. We found self-efficacy to be a significant predictor for both groups of men, together with perceived severity for homosexuals and response efficacy for heterosexuals. Next, we analyzed HIV-directed condom usage communication materials and found that the use of threat appeal themes is more common than themes promoting self-efficacy. Implications for health communications and policy are discussed.

Understanding women's mammography intentions: a theory-based investigation

The present study compared the utility of two models (the Theory of Planned Behavior and Protection Motivation Theory) in identifying factors associated with intentions to undertake screening mammography, before and after an intervention. The comparison was made between the unique components of the two models. The effect of including implementation intentions was also investigated. Two hundred and fifty-one women aged 37 to 69 years completed questionnaires at baseline and following the delivery of a standard (control) or a protection motivation theory-based informational intervention. Hierarchical multiple regressions indicated that theory of planned behavior variables were associated with mammography intentions. Results also showed that inclusion of implementation intention in the model significantly increased the association with mammography intentions. The findings suggest that future interventions aiming to increase screening mammography participation should focus on the theory of planned behavior variables and that implementation intention should also be targeted.

Effects through 24 months of an HIV/AIDS prevention intervention program based on protection motivation theory among preadolescents in the Bahamas

OBJECTIVES

The purpose of this work was to report the intervention effects of Focus on Youth in the Caribbean (youth HIV intervention), an HIV prevention intervention based on protection motivation theory, through 24 months of follow-up on sexual risk and protection knowledge, perceptions, intentions, and behavior among Bahamian sixth-grade youth.

METHODS

We randomly assigned 1360 sixth-grade youth (and their parents) attending 15 government elementary schools in the Bahamas to 1 of 3 conditions: (1) youth HIV intervention plus a parental monitoring/communication/HIV education intervention; (2) youth HIV intervention plus a parental goal-setting intervention; or (3) an environmental protection intervention plus the parental goal-setting intervention. Baseline and 4 follow-up surveys at 6-month intervals were conducted. Intervention effects were assessed using the mixed model for continuous outcome variables and the generalized linear mixed model for dichotomous outcome variables.

RESULTS

Through 24 months of follow-up, youth HIV intervention, in combination with the parent interventions, significantly increased youths' HIV/AIDS knowledge, perceptions of their ability to use condoms, perception of the effectiveness of condoms and abstinence, and condom use intention and significantly lowered perceived costs to remaining abstinent. There was a trend for higher condom use among youth in the Focus on Youth in the Caribbean groups at each follow-up interval.

CONCLUSIONS

Focus on Youth in the Caribbean, in combination with 1 of 2 parent interventions administered to preadolescents and their parents in the Bahamas, resulted in and sustained protective changes on HIV/AIDS knowledge, sexual perceptions, and condom use intention. Although rates of sexual experience remained low, the consistent trend at all of the follow-up periods for higher condom use among youth who received youth intervention reached marginal significance at 24 months. Additional follow-up is necessary to determine whether the apparent protective effect is statistically significant as more youth initiate sex and whether it endures over time.

Using the theory of planned behaviour to understand the motivation to learn about HIV/AIDS prevention among adolescents in Tigray, Ethiopia

Various studies indicate that school- or university-based HIV prevention curricula can reduce the prevalence of sexual risk behaviour among adolescent youth in Sub-Saharan Africa. However, effective HIV/AIDS prevention education may be problematic, if the needs of youth are not served adequately. To date, little attention has been given to the motivation of youth to learn about HIV/AIDS and about their preferences for HIV/AIDS curriculum design options. The aim of this study was to get insight into the determinants of the motivation of youth to learn about HIV/AIDS prevention and to assess their curriculum design preferences. Students from a university in Tigray, Ethiopia, filled out a structured questionnaire, which assessed demographics, variables that according to the Theory of Planned Behaviour are related to the motivation to learn, and their preferences for independent, carrier and integrated HIV/AIDS curriculum designs. On average, participants were highly motivated to learn about HIV/AIDS. Motivation to learn was primarily related to social norms and was not related to self-efficacy to discuss HIV/AIDS in class. The often discussed reluctance to discuss sexuality and condom use in curricula in Sub-Saharan Africa, seems to be more related to existing negative social norms, than to lack of self-efficacy. Participants revealed a high preference for the independent, carrier and integrated curriculum design options. However, students with a higher motivation to learn about HIV/AIDS were more attracted to the independent course design.

Longitudinal predictability of sexual perceptions on subsequent behavioural intentions among Bahamian preadolescents

Objectives: To assess the relationship of baseline behavioural intentions and sexual perceptions with subsequent intentions regarding sexual initiation and condom use in Bahamian preadolescents. Method: Longitudinal data were obtained at baseline and 8 months later from 424 sexually inexperienced Bahamian youth aged 9–12 years, who served as ‘controls’ in a HIV risk-reduction intervention study. Sexual perceptions were measured based on a social cognitive model, protection motivation theory. Results: Baseline intention to have sex was a strong predictor of follow-up intention to engage in sex for boys, but was not a predictor for girls. Baseline condom use intention was not related to subsequent intention to use condoms for either male or female youth. Perceptions of girls, compared with boys, were less endorsing of sexual initiation. Some protection motivation theory constructs regarding sexual perceptions were predictive of subsequent behavioural intentions. Among boys, low perceived self-efficacy to avoid sexual intercourse and positive feelings about having sex predicted their intention to have sex. Among girls, perceived peer sexual behaviour and a limited understanding of the adverse consequences of sexual intercourse were predictors of their subsequent intention to initiate sex. Perceived self-efficacy to use condoms and response efficacy of condom use were significant predictors of condom use intention for both boys and girls. Conclusions: These results suggest that prevention intervention efforts should target predictive perceptions and consider sex differences in sexual perceptions.

Theory of planned behaviour predictors of intention to use condoms among Xhosa adolescents in South Africa

HIV/AIDS is taking a heavy toll on South African youth. Reducing their risk for HIV requires an understanding of the determinants of their HIV risk behaviours that are amendable to intervention-induced change. This study draws upon the theory of planned behaviour to identify the modifiable determinants of the intention to use condoms among Xhosa-speaking South African adolescents. The participants were 390 Xhosa-speaking 6th grade students (mean age = 12.1 years) in public schools in the township of Mdantsane, South Africa who completed an anonymous questionnaire. Multiple regression revealed that attitude and perceived behavioural control were significantly related to the intention to use condoms, whereas subjective norm was not, controlling for sexual experience, gender, and language preference. Consistent with this were additional analyses using beliefs as predictors: Hedonistic behavioural beliefs and control beliefs about condom-use negotiation and technical skills predicted intention, whereas normative beliefs did not. The theory of planned behaviour may be a useful model of condom use among Xhosa-speaking South African adolescents. An emphasis on beliefs about the adverse effects of condom use on sexual enjoyment, the ability to negotiate condom use, and the ability to use condoms correctly might improve the efficacy of HIV/STD interventions for such adolescents.